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r p� <br /> SAN JOA 1 COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> y 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> F. <br /> ;e Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> OR� <br /> VECTOR CONTROL INSPECTION FORM <br /> FDBA INSPECTIO DAT <br /> Structure Operation 7 is 13 <br /> El El 1. Well Construction EMISE ADDRESS j RE-INSPECTION DATE <br /> ❑ ❑ 2. Cross-Connection <br /> 1.2 7,5j ® / di <br /> Structure Operation Manure Mana erne NER/ PERATOR PHONE <br /> ❑ ❑ 3. Spreading and Dis ng , ),3.2 9d6 <br /> ❑ ❑ 4. Concrete Tanks INSPECTION TYPE V PROGRAM ELEMENT RECORD ID <br /> ❑ ❑ 5. Lagooning I P4 C <br /> ❑ ❑ 6. Composting The items below represent code violations and must be corrected: <br /> Structure Operation Bird DISpos <br /> ❑ ❑ 7. Bu in h 2'of Cover l `� <br /> ❑ ❑ 8. Approv d Concrete Tank <br /> ❑ ❑ 9. Rem al from Premises e44112 <br /> Structure Operation Vect control <br /> ❑ ❑ 10. omestic FI <br /> El 11 Fannia FI , <br /> ❑ ❑ 16. Larvae f i'L <br /> ❑ ❑ 13. Pu ae <br /> ❑ ❑ Y 14. Adult <br /> ❑ ❑ 15. Li ht Population <br /> 1:1EV 16. Moderate Po ulation I`� <br /> ❑ 17. Heavy Population <br /> Structure 096ration Feeding/Water <br /> ❑ ❑ 18. Water Troughs <br /> ❑ ❑ 19. Cups or Bowls <br /> El 20. Food Storage <br /> Structu Operation Houses F-00 ® aa~ew <br /> r <br /> ❑ 21. Floors <br /> ❑ 1 22. WaIWCeilin s <br /> ❑ 23. Cleanin Fre uenLLEEM I i - -11HEMEM <br /> �® <br /> Structure Operation Water Well <br /> ❑ ❑ 1. Well Construction <br /> El 2. Cross Connection <br /> Structure Operation Floors 77 <br /> 11 3._properlyGraded to Sewer <br /> ❑ ❑ 4. Drain <br /> ❑ ❑ 5. Smooth/Cleanable <br /> 6. Covin <br /> El El 7. Cleaning Frequency <br /> Structure Operation Walls a /!i <br /> ❑ ❑ . Smooth/Cleanable <br /> ❑ ❑ . Cleaning Frequency <br /> Structure Operation Cages <br /> ❑ ❑ 10. Condition <br /> 11. Sanitation <br /> Structure Operation Food <br /> ❑ ❑ 12. Storage <br /> 11 13. Insect/Vermin <br /> Structure Operation Animal Disposal <br /> ❑ ❑ 14. Removal from Premises <br /> ❑ ❑ 5. Other <br /> Structure Operation Sewage Disposal <br /> ❑ ❑ 16. Septic System <br /> ❑ ❑ 17. Sewer <br /> Structure Operati Rabies Vaccination REC Y w INSPECTOR r <br /> El 1:118. Certificate on Premises <br /> VECTOR CONTROL INSPECTION FORM <br /> EHD 40-06 4/6/12 Page of <br />